首发精神分裂症患者的运动协调功能与前额叶白质及皮质脊髓束完整性

目的:应用弥散张量成像(DTI)探讨首发精神分裂症患者神经系统软体征中的运动协调功能与前额叶白质及皮质脊髓束各向异性比值(FA)的关系。方法:纳入42例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的首发精神分裂症患者和46例年龄、性别及受教育年限相匹配的健康对照。两组研究对象均用剑桥神经科检查(CNI)评定神经系统软体征,并接受头颅磁共振成像检查。用阳性与阴性症状量表(PANSS)评估患者组基线和半年后的临床症状。用感兴趣区测定的方法,分析患者组和对照组神经系统软体征中的运动协调领域分与前额叶白质及皮质脊髓束各层面(内囊、大脑脚、小脑中脚水平)FA值间的关系。结果:神经系统软体征中的运动协调领域分在患者组中与前额叶白质FA值呈正相关(r=0.35,P0.05),在健康对照中则与小脑中脚水平皮质脊髓束FA值呈正相关(r=0.34,P0.05)。将患者按半年后阴性症状分为高分组和低分组,高分组运动协调领域分与前额叶白质(r=0.68,P0.05)呈正相关,与小脑中脚水平皮质脊髓束(r=-0.67,P0.05)FA值呈负相关;低分组则与内囊FA值呈正相关(r=0.60,P0.05)。结论:本研究提示首发精神分裂症患者半年后阴性症状高分组、低分组及正常人群中,运动协调功能相关的脑区分别为前额叶、内囊和小脑中脚层面的皮质脊髓束,提示有必要进一步研究运动协调功能相关的脑区不同对患者预后的预测意义。

motor coordination and white matter integrity in prefrontal lobe and corticospinal tract in first-episode schizophrenia

Objective:To investigate the correlation between motor coordination in neurological soft signs and fractional anisotropy(FA) value of prefrontal white matter and corticospinal tract in patients with first-episode schizophrenia.Methods:Forty two first-episode schizophrenic patients meeting the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ) and 46 normal controls matched on age,gender and education underwent neurological examination with excerpt of Cambridge Neurological Inventory(CNI) and diffusion tensor imaging(DTI).Symptom evaluation with PANSS was conducted at baseline and 6-month follow-up.Results: Motor coordination was positively correlated with FA value of prefrontal whiter matter in patients(r=0.35,P<0.05),while in controls it was positively correlated with FA value of corticospinal tract(r=0.34,P<0.05).Motor coordination was positively correlated with FA value of prefrontal whiter matter(r=0.68,P<0.05) and negatively correlated with corticospinal tract(r=-0.67,P<0.05) in patients with severer negative symptoms at 6-month follow-up,while it was positively correlated with FA value of internal capsule(r=0.60,P<0.05) in patients with milder negative symptoms.Conclusion: Motor coordination in neurological soft signs may be related to white matter integrity in prefrontal lobe,internal capsule and corticospinal cord in patients with severer negative symptoms at 6-month follow-up,patients with milder negative symptoms and normal controls,respectively.The differences of regions correlated with motor soft signs suggest different pathologic impairment occur in patients with different symptoms,and may predict negative symptoms at 6-month follow-up.